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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In one of the LinkedIn threads I was participating, Cameron Collette offered this really interesting insight:

Secondly, there is a general unwillingness to change current work flow models in many health care facilities. Daily I hear, “we have never done it that way” or “that’s not the way do things”. So, we have what is currently a greater than 40% EMR adoption failure rate. In other words, it is not always a technology failure. The technology might work, but in order to make it work properly requires a significant change in processes. Sometimes this would be a good thing. Sometimes it would not be a good thing as a lot of EMR/EHR designs were developed with virtually no real input from the people that have to work with them every day.

He’s absolutely right. It is very often the case that the problem with your EHR has nothing to do with the EHR technology at all. Often, one of the biggest problems that’s faced during an EHR implementation is a change to culture.

I’ve said multiple times that an EHR implementation requires change. I know that many EHR companies will try and sell you that their product can be implemented with no change to your workflow. That’s just an outright lie. Sure, some of them can do a pretty good job modeling your current workflow in the EHR, but there is still plenty of change that’s required.

Change and EHR implementation go together. Organizations that deny this reality have issues in their EHR implementation.

This is why every EHR implementation I’ve seen has required some powerful leadership that drives the initiative. It’s why the $36+ billion in stimulus money has driven EHR adoption so much. That money makes leaders respond.

My best advice for healthcare leaders out there is to embrace the change that EHR and other technology is bringing. You shouldn’t accept mediocrity in a tech system, but you should expect and be ready to change when you implement an EHR. In fact, one of the best assets you can build into your company is the ability to adapt to change.

5 years from now, I’m pretty sure we’re going to look back and think that the next 5 years of technology caused more change for good than we’ve seen in the last 10 years. If your organization doesn’t have a culture of adapting to change, they’re going to be left behind.

The following is a guest post by Angela Carter, marketing manager at ChartLogic.
A major concern physicians have dealt with over the past 10–15 years has been choosing the right EHR solution for their practice. With the rise and fall of numerous electronic health record companies, that concern has evolved to whether a chosen EHR will still be in business five years from now.

According to the Centers for Medicare and Medicaid Services (CMS), there are over 900 EHR vendors currently on the market, many of whom offer more than one product. In some ways, the huge number of EHR choices has been a good thing for healthcare; it has forced vendors to be more innovative and to cater to the needs of their users. However, the market can’t possibly sustain this many similar projects for long. Eventually, small vendors will be swallowed up by larger vendors and many others will simply go out of business.

So how do you know if your EHR vendor will survive the EHR purge that has already started? Of course there is no way of knowing for sure, but below are a few questions you can ask yourself that will give you a good idea of your EHR’s future.

1. How long has the vendor been in business?

Past performance is usually a good measuring stick for the future. Hundreds of vendors were born after the HITECH Act was passed in 2009, which means that most EHR vendors are still relatively new. Newer EHR companies aren’t necessarily a bad thing—some of them are actually better than some of the legacy systems that have been around for decades—but be wary of any company that doesn’t have the years in business to back it up. A vendor that has already proven it has weathered the EHR storms for 10–15 years will be much more likely to survive current and future challenges than the new, promising EHRs.

Don’t just look at how long the vendor has been in business, though. Research the vendor’s track record as well. If your vendor has a high retention rate—90 percent or higher—then you’re in good company.

2. How usable is the EHR?

For years, doctors put up with EHRs that didn’t meld with their workflow, but that tolerance is coming to an end. Black Book Rankings called 2013 “The Year of the Great EHR Switch” because most EHR implementations happened in practices that were on their second or third EHR. The reason for this shift? Usability. Eighty-seven percent of doctors cited usability as their primary complaint about EHRs. (Source: http://www.prweb.com/releases/2013/7/prweb10926499.htm)

For some reason it took many years for usability of EHR systems to catch on, but now that it has, the difficult-to-use systems will have a difficult time holding on to customers. Point-and-click EHRs have never been popular among physicians, especially those who see 50+ patients a day. EHRs that utilize voice technology, though, are growing in popularity. It is highly unlikely that any EHR system will cater 100 percent to a physician’s needs and preferences, but voice offers much more flexibility than traditional point-and-click systems do, not to mention voice-driven systems are more likely to follow the workflow physicians already use.

3. How well does your vendor understand your specialty?

The reason the industry hasn’t settled on just a couple of vendors by now is because workflow among different specialties varies so widely. Physicians need vendors that are very good at their specialty, not those that claim to answer to the needs of all physicians. A vendor that dedicates itself to producing and improving capabilities that align with your specific needs will take much better care of you. Not only that, but they will be more able to evolve with you as technological demands change, giving the company more stability in a shaky market.

4. How’s the support?

Never underestimate the power of a good support team. Most EHRs aren’t designed to work flawlessly fresh out of the box; you need adequate training and ongoing support, too. A recent Software Advice survey revealed that about 60 percent of respondents reported “learning to use the system” as a one of the main challenges with their EHR, even more challenging than achieving meaningful use or finding costs to support the system. (source: http://www.softwareadvice.com/medical/userview/ehr-survey/)

As a business metric, support may be even more powerful than usability, especially since federal regulations keep tightening, limiting the freedom to change certain aspects of an EHR. A vendor that communicates with its customers regularly will stand out.

5. Is the vendor ready for meaningful use stage 2? ICD-10?

Over a thousand vendors certified for meaningful use the first time around. Less than 40 of those vendors have received complete ambulatory certification required for 2014. Add ICD-10 to the mix and very few vendors will be able to keep up with these increasingly difficult technological advancements. Vendors that don’t have a plan already in place regarding how they will re-certify for meaningful use and be ICD-10 compliant will be among the first to go.

A vendor that scores well in each of the five questions above will most likely have what it takes to make it through the next five years.

Angela Carter is a marketing manager at ChartLogic, an EHR for orthopedists, ENT doctors, and other specialists. In addition to managing all of the company’s content, she writes regular blog posts for various health IT sites. She is also the associate editor for Utah Technology Magazine, a start-up magazine that aims to tell the tech story happening in Utah.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You should know the drill by now. Each weekend, I go through and list some of the interesting, insightful, entertaining, news-worthy or otherwise notable tweets that I find covering my favorite topics of EMR, EHR and healthcare IT.

I have a feeling a few of these tweets will drive some interesting discussion around EHR. I hope they do since I do enjoy a nice discussion.

First up is a tweet that’s pretty profound to consider when we think about EMR:

“day that the EMR effectively disappears from view will be the day we finally get it right” ehr.bz/yj RT @ReasObs#EHR…invisible?

I think the EMR has disappeared for a number of clinicians, but not enough. Maybe this supports my comment in a previous post that we hear a lot of stories of failed EMR implementations, but we don’t hear the stories of as many successful EMR implementations. Is that because those EMR that are so successful basically disappear. Reminds me of life where you start to take for granted something that at first was such a game changer.

@sippigrrrl Remember, I am building the EMR system for the Doctor I seem and the hospital I will go to… I want them happy :-/

My first gut reaction to this tweet was the need to link my really old post, “Develop Your Own EMR, Are You Crazy?” Although, this seems like a little bit different situation. I do wonder how many people developing EHR software end up seeing doctors who use that same software. I wonder if they’d have different priorities and/or if they’d take different approaches if their healthcare was the only motivator behind the EHR software they developed.

This one’s a little self congratulatory I admit, but I always love to see people tweeting my posts. Plus, I love to see how they frame what I’ve written. I prefer to look at that post as a look at ways that EHR can still improve, not as an ode to paper or even worse an excuse for doctors to still use paper. If you liked that post, look forward to another post this week in the “Healthcare Spoiled” series.

@danamlewis#hcr is not ready for the data yet… at least on an office, hosp, EMR, level….:-(#hcsm

This is very true. We’re not ready to handle all the healthcare data that’s being produced today, let alone the tsunami of healthcare data that will come. I’m not too concerned though. It means there’s a tremendous opportunity on the horizon for an entrepreneur to do something amazing.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Just sitting back and taking a look at the current EHR and EMR market, I have a strong feeling that we’re going to see a number of EHR vendors close up shop. Many of them may be disguised as purchases by bigger vendors who are trying to gain market share. Others will probably just close their doors completely and users of that EHR system will wonder why their support requests aren’t getting the response from their EHR vendor that they’re use to receiving.

I’ve talked previously about how EHR adoption will be slowed by the HITECH act. This slowing of EHR adoption is going to put a number of EHR vendors out of business. I have a feeling that far too many EHR vendors based their burn rate on their previous sales. Now that sales have slowed, they’re going to have to really fight to stay above water.

For those concerned, you might want to take a look back at my post on assessing your EHR vendor’s financial situation. Plus, I think it’s definitely worth taking a look at some contingency plans you have in case your EHR vendor does fail or get bought out.

The nice part of client-server based EHR systems is that you can usually keep using the EHR regardless of the financial viability of the EHR company itself. Granted, you’ll stop getting upgrades, but at least you can maintain the status quo. If you’re using an SAAS EHR, I’m not sure exactly what options you have available.

I should say that most EHR vendors won’t just shut their doors and leave. Most failing EHR companies will salvage what they can by selling to an EHR vendor that wants their customer base. However, when this happens, expect the new vendor to provide very light support for the purchased EHR software and a clear path to move to their software.

All of this said, I’m predicting a number of EHR companies to fail in the coming year.

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